Intususcepción: diagnóstico y manejo en niños y adultos. Rev Med Cos Cen ; 73 (). Language: Español References: Page: PDF: . Intestinal intussusception secondary to myofibroblastic tumour in an elderly patient. Case reportIntususcepción intestinal secundaria a tumor miofibroblástico en. Intususcepción e invaginación son los términos que se utilizan para describir la introducción en forma telescópica espontánea de una porción del intestino en.
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Adult intussusception – 14 case reports and their outcomes. University General Hospital J.
Intususcepción en el adulto: Revisión de 14 casos y su seguimiento
Data related to demographic and clinical features, complementary explorations, presumptive diagnosis, treatment, follow-up, and complications were collected. The most reliable diagnostic technique was computed tomography 8 diagnoses from 10 CT scans.
A preoperative diagnosis was established in 12 cases. Invaginations were ileocolic in 8 cases the most commonenteric in 5, and colocolic in 2 coexistence of 2 lesions in one patient. The etiology of these intussusceptions was idiopathic or secondary to a lesion acting as the lead point for invagination.
Depending on the nature of this lead point, the cause of the enteric intussusceptions was benign in 3 cases and malignant in 2. Ileocolic invaginations were divided equally 4 benign and 4 malignantand colocolic lesions were benign 2 cases. Conservative treatment was implemented for 4 patients and surgery for 10 7 in emergency.
Five right hemicolectomies, 3 small-bowel resections, 2 left hemicolectomies, and 1 ileocecal resection were performed. The lesion disappeared after 3 days to 6 weeks in patients with conservative management. Mean follow-up was Surgery is usually necessary but we favor conservative treatment in selected cases.
Se siguieron durante 28,25 meses de media rango meses. For this reason it is important to remember that diagnosis is difficult; unlike its presentation in childhood the etiology of the lead point for invagination usually corresponds to a structural lesion, very often malignant in nature, this is why it is advisable to establish a syndromic and etiological diagnosis.
The present study analyzes symptoms, complementary tests, and lesions, together with their management and subsequent follow-up, in patients over the year history of our hospital. A retrospective descriptive study was conducted on all patients aged over 16 years who were diagnosed with intestinal invagination, both preoperatively and postoperatively, between January and January in any of the clinical departments at Morales Meseguer University Hospital Murcia, Spaina center serving a population of aroundinhabitants.
Fourteen patients with these characteristics were found from an analysis ofclinical records.
Invaginación – Síntomas y causas – Mayo Clinic
We reviewed demographic data age, sex, service in which they were diagnosed, etc. We decided to define the following types of invagination: We also classed the etiology of the lesions composing the lead point for invagination as benign or malignant.
The cases in which no causal lesion was found were included in the benign lesion group. Five of these patients had previous abdominal surgery 2 appendectomies, 2 caesarean sections, and 1 low anterior resection for rectal cancer four years earlier, with normal follow-upsand one required a hematopoietic progenitor allotransplant for acute myeloid leukemia M5with normal follow-ups, six years prior to the diagnosis with intussusception.
However, the peediatria that yielded diagnostic accuracy in order of frequency were: CT 8 from 10 cases were diagnosed correctlyabdominal ultrasonography 6 preoperative diagnoses of the 12 who received itopaque enema 2 diagnoses of the 4 tests performedcolonoscopy 2 diagnoses from 5 testsdouble balloon enteroscopy a single case and a single correct diagnosisand intestinal transit with no diagnosis.
There were only two patients intususcepcipn whom diagnosis was established intraoperatively: The most accurate complementary test for preoperative diagnosis for most patients was abdominal CT.
The most common locations Table III were ileocolic 8 casesfollowed by enteric 5 cases and colocolic 2 cases. The types of intussusception were classed in turn according to their benign or malignant etiology at the lead point. Enteric invaginations were benign in 3 of the cases and malignant in 2. The nature of the lesion in the ileocolic invaginations was divided equally between benign and malignant 4 cases of each. Lastly, colocolic lesions, the least common in our pediatriia, were all benign.
Seven of the operated upon patients required emergency surgery for signs of ischemia or sepsis, whereas the rest were able to receive elective surgery. The type of operation varied according to location, lesion size, cause of lead point for invagination, and bowel viability.
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Thus we performed 5 right hemicolectomies with resection of the invaginated ileum, 3 small bowel resections, 2 left hemicolectomies, and 1 ileocaecal resection.
In the four patients diagnosed radiologically who did not undergo surgery half of the invaginations were enteric and resolved spontaneously, as shown by subsequent ultrasonography or Inususcepcion follow-ups at 2 and 3 weeks ; furthermore, both were a casual finding one during complementary tests for a recently diagnosed Crohn’s disease, and one during the study of a different non-digestive abdominal pathology.
The two remaining unoperated cases presented with intususcfpcion intussusception, the etiology of which was in one case secondary to pancolitis in a patient undergoing transplantation for AML-M5, and in the other due to nodular lymphoid hyperplasia confirmed by biopsy Table IV. The four unoperated patients were followed up for a mean of months range: As regards the complications or sequel of surgery, it is worth noting just three cases of minor morbidity seroma, phlebitis, and eventrationand a major complication conditioned by the etiology of a lead point: Intestinal invaginations are a complex disorder with multiple therapeutic options that have not been standardized due to the impossibility of collecting a sufficient number of study patients.
The present review aims to show our hospital’s year experience with this condition: The mean age at presentation in our study was However, we observed a substantial difference to other studies, which lies in the nature of lesions.
It is true that there is a greater predominance of enteric vs. In the small bowel they are characterized as benign lesions such as hamartomas, lipomas, leiomyomas, inflammatory adenomas, Meckel’s diverticulums, adhesions, etc.
In the colon the possibility of malignancy is greater 5,7,8 usually adenocarcinomas. The clinical presentation of invaginations is diverse: Nevertheless, the fact that 12 of our 14 cases were preoperatively diagnosed suggests the use of an adequate imaging technique; despite ultrasonography being the most frequently used technique it did not guarantee a diagnosis on most occasions, which is why subsequent abdominal CT 11 was recommended, which did reveal the intussusception and its location.
However, the etiology is difficult to determine in a preoperative study, since edema or hemorrhagic intussusception may simulate a mass at this level 12which is why the etiological diagnosis will be established either with other biopsy-related tests or during pathological examination after sampling. Many reviews support invagination as an indication for surgery in adults due to the risk of intestinal ischemia and possible malignancy of the lead point of invagination.
However, we consider it important to take associated symptoms into account and on the basis of these conduct more accurate diagnostic studies to rule out a tumor origin if not done previously; moreover, the diameter and length of the invagination, together with the presence or absence of an associated lesion, and the type of invagination are predictors of spontaneous resolution 13, The present review highlights the analysis of patients in whom conservative management was chosen due to the absence of clinical manifestations and of a demonstrable lesion as lead point of invagination.
This suggests the possibility of spontaneous invaginations with a still unknown incidence and a conservative treatment as yet not promulgated by many surgeons Many reviews consider a reduction prior to resection, which we rule out with any type of invagination due to a possible mobilization of a non-benign lesion and our doubts as to bowel viability if it required surgery for associated symptoms.
We conclude that invaginations are a disorder to bear in mind when primarily diagnosing an acute abdomen, and that in selected cases we favor a new treatment depending on intussusception location and the radiological presence of an associated lesion. This is shown by our series of patients diagnosed with enteric invagination but with no signs of lesions, who were treated conservatively and showed a satisfactory resolution of symptoms only a few days after diagnosis.
Am J Surg ; Intussusception in the adult-a rare disease. J Emerg Med ; 9: Clinical spectrum and surgical approach of adult intussusceptions: Int J Colorectal Dis ; 21 8: Int J Colorectal Dis ; 20 5: Azar T, Berger DL. Ann Surg ; Unusual cases of intussusception. Subacute intestinal obstruction secondary to colonic lipoma intussusception.
Rev Esp Enferm Dig ; 3: Dis Colon Rectum ; 49 Clinical entity and treatment strategies for adult intussusceptions: Dis Colon Rectum ; 50 Rev Esp Enferm Dig ; 99 Radiol Clin North Am ; 41 6: Approach to management of intussusception in adults: Am Surg ; 73 Dig Surg ; 20 5: Acute intestinal intussusceptions in adults: Ann Chir ; 8: Aguayo-Albasini General Surgery Department.
Patients and methods A retrospective descriptive study was conducted on all patients aged over 16 years who were diagnosed with intestinal invagination, both preoperatively and postoperatively, between January and January in any of the clinical departments at Morales Meseguer University Hospital Murcia, Spaina center serving a population of aroundinhabitants.
Discussion Intestinal invaginations are a complex disorder with multiple therapeutic options that have not been standardized due to the impossibility of collecting a sufficient number of study patients.